Is menopause being over-medicalised?

Michelle Wisbey

7/03/2024 4:12:50 PM

The authors of a landmark investigation are demanding a new approach, but outside experts warned against shifting too far from established treatments.

Female GP speaking to patient.
The typical age at menopause is around 50 years old, with around 12% of women experiencing the condition earlier.

It is a healthy part of ageing for half of the world’s population, but menopause has long been a taboo subject, hidden by generations of silence.
Now, a coalition of Australian researchers is working to bring menopause out of the shadows – arguing for a societal change and a mindset shift for GPs.
Through a high-profile series published in The Lancet, the group is arguing menopause has suffered from an ‘over-simplified narrative’ and is perceived as a ‘health problem to be solved by replacing hormones’.
It calls for a new approach to menopause management, which empowers women to access high-quality information about symptoms and treatments, empathic clinical care, and workplace adjustments.
‘Rather than focusing on menopause as an endocrine deficiency, we propose an empowerment model that recognises factors modifying the experience,’ the paper said.

The series outlines four key areas of change:  

  • An empowerment model for managing menopause
  • Optimising health after early menopause
  • Promoting good mental health over the menopause transition
  • Managing menopause after cancer
According to the series’ co-author, University of Melbourne Professor Martha Hickey, there is a long-held misconception that menopause leads to a decline in physical and mental health.
She said this must be challenged across the whole of society, including by healthcare professionals.
‘Changing the narrative to view menopause as part of healthy ageing may better empower women to navigate this life stage and reduce fear and trepidation amongst those who have yet to experience it,’ Professor Hickey said.

‘Our series calls for an individualised approach where women are empowered with accurate, consistent, and impartial information to make informed decisions which are right for them over the menopause transition.’
The series said there has been a global tendency to focus only on the negative experiences of menopause, depicting it as an ‘unfortunate and distressing experience’.

Series co-author Dr Lydia Brown said while some women go through an extremely negative experience, it is not guaranteed.

‘The reality is much more complex and varied, with some women reporting neutral experiences and others highlighting good aspects, such as freedom from menstruation and menstrual pain,’ she said.
The researchers are now calling out healthcare professionals, saying they need to ensure patients have the knowledge to make informed decisions around menopause.
The typical age at menopause is around 50 years old, with 12% of women globally experiencing menopause between the ages of 40 and 44.
The paper states that women who enter menopause at younger ages can feel distress and less supported, and there is a gap in clinical guidance for early menopause.
For this reason, co-author Dr Andrea La Croix said it is important that information about treatments, their benefits, risks, and comparative effectiveness are made readily available to all women.
‘[Menopausal hormone therapy] MHT is the best-known medication and data suggests it’s slightly more effective than alternative medications for treating hot flushes and night sweats,’ she said.
‘However, no medication can reliably resolve all negative experiences during menopause and commercial interests have influenced how MHT is presented – overshadowing evidence-based alternative options.’
The research also suggests new strategies are needed to promote good mental health throughout the menopause transition, while responsibly preparing and supporting those at risk.
More supportive and inclusive workplace cultures are another area for improvement, with studies finding women want their managers to be informed and empathetic about menopause.

The investigation has garnered the attention of experts from across the globe.
National Association of Specialist Obstetricians and Gynaecologists President Associate Professor Gino Pecoraro has welcomed the more open discussion about menopause.
But he warns that doctors must be careful ‘not to undo any good that has already been done’.

‘No doctor treating a woman suffering from menopausal symptoms would deny the role of empowerment and non-pharmacological treatments to help sufferers better deal with this transition,’ he said.
‘However, there remains a place for symptom control with hormonal and non-hormonal medical therapies.

‘Rather than trying to pitch one model of treatment over another, wouldn’t it be great if women and their doctors were aware of all treatment options and individualise treatment to the particular needs of each woman seeking their help?’
Meanwhile, the Director of Monash University’s Women’s Health Research Program, Professor Susan Davis, said it is disappointing that health empowerment has not already been applied to menopause.
She said empowering women to best navigate menopause through the provision of credible health information to support informed and shared decision-making, has been the focus of national and international organisations for many years.

‘The authors caution against “over-medicalisation” of the menopause but the messaging regarding [hormone] therapy is mixed, and potentially confusing,’ Professor Davis said.
‘The authors seem determined to minimise the important role of MHT in helping many women as they reach menopause.
‘They ignore other published systematic reviews which all agree that MHT is the most effective treatment for vasomotor symptoms, is as effective as other bone-specific therapies [antiresorptive agents] in reducing post-menopausal osteoporosis and associated fractures.’
But in conclusion, the authors said society must shift its view on women in mid-life, and appreciate their contributions and skills, especially in the workforce.
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Dr Christine Colson   7/03/2024 6:06:39 PM

If we could erase the word 'menopause' from the lexicon, imagine the joy. It instills a dread in women who see themselves approaching it and in those who see themselves in it. It's almost a destination, a dreaded place. The 'advice' from friends, family and health professionals is almost unbearable. How to undo the conundrum? Alas, it's too late.

Dr Angela Maree Roche   8/03/2024 11:05:58 AM

Is menopause being over medicalised ? Simple answer - no .

Dr Peter James Strickland   8/03/2024 12:53:29 PM

The authors seem to arguing that menopause is not an hormonal problem alone. We treat all other hormonal problems (esp thyroid, adrenal etc) with medications successfully. Not giving a women in severe menopause replacement hormones appears to me to be negligent if needed. I have seen dramatic improvements in women's lives by giving replacement oestrogen and progesterone supplements, and it is known to prevent osteoporosis as well, save relationships in families, and help the women with their work and friends. It is a no-brainer --treat the deficiency, as we would with hypothyroidism or Addison's disease etc. , and also any other problems in physical and psychological health whilst on the HRT. Otherwise you simply don't know!

Dr Christine Colson   8/03/2024 7:58:03 PM

Is menopause being over medicalised ? Well, um... I mean, let's face it. It's everywhere. It's inescapable. I'ts more than health. It's PC. Dare anyone answer yes? Even, maybe? Modern medicine, for all its marvels, needs to 'reflect' and be balanced and not so dictatorial

A.Prof Christopher David Hogan   9/03/2024 10:55:25 AM

Gosh, Talk about selection bias!
Judging by my outer urban practice & the experience of my rural registrars, I would have to say that many patients are violently opposed to medication for menopause, even when it is needed. Complementary therapy however, is very, very commonly self administered!

Dr Shobha Balu   9/03/2024 12:34:41 PM

Menopause use is for real; In some women, the post menopausal symptoms could be depressing. Sudden lack of hormones could wreck one's sex life and cause issues in a marriage. Hormone replacement will help to function better sexually and physically. Women are living longer and leading a productive life for long also. Women are better informed and are seeking information on bio identical hormones.

Dr Angela Maree Roche   9/03/2024 6:44:25 PM

This “investigation” of a “ new approach” to “empower” women with an “ individualised approach” by “calling out healthcare professionals saying they need to ensure patients have the knowledge to make informed decisions around menopause” appears to be about 22 years behind the times. Prior to the Womens Health Initiative Study on Hormone Therapy in 2002, hormone therapy was thought to be protective for conditions such as heart disease and dementia and was widely prescribed for preventative purposes. Once the initial data showed increased rates of breast cancer, heart disease and strokes in users , enormous changes in the use of hormone therapy was triggered. Since then the General Practice teaching has always been individualised therapy only, for symptoms only, the woman’s decision only - after she has been presented with the risks and decided that the symptoms warrant this type of medical therapy for the benefit of her quality of life. So , what is the real agenda behind this ?

Dr Marietjie Van Der Merwe   10/03/2024 5:52:21 PM

It is a slap in the face to suggest that GPs do not individualise management of menopause. We know that it is never one size fits all, not in any disease. It is the time of a woman's life when many other things are happening, she is often at the peak of her career or the children are leaving home. Yes, in an ideal world workplaces should be receptive to this and allow a woman some space or understanding during menopause. What about PMS or PMDD?
As GPs we listen to woman, we make sure we understand all their symptoms. We also make sure it is indeed menopause. We offer them more information to educate themselves about the changes and also how it can be managed. We use the opportunity to make sure cardiovascular health and bone health get looked after. But really if there is one thing(MHT) that can potentially manage all the symptoms, and there are no contra indications, we should offer this to all women suffering in this time of their life.

Dr Josiah Benjamin Salagaras   11/03/2024 2:38:21 PM

Agree with Dr Marietjie Van Der Merwe, isn't individualised treatment what we do on a daily basis?
And at least anecdotally, my experience is contrary to the authors' question re over-medicalisation in that the number of perimenopausal or postmenopausal women I see who are experiencing troubling symptoms and have not been offered any medical management or have been put straight on an SSRI without any discussion of MHT is actually shocking to me. If anything, for many women, there hasn't been ENOUGH input medically into their wellbeing at menopause.

Dr Hema Iyer   16/03/2024 11:33:33 PM

No,Menopause management has not been overmedicalized. On the opposite since the WHI study results were released, patients themselves were not accepting mht for their symptoms. As Gp's we always provide all options. natural otc, lifestyle changes, family history considerations .if symptoms are still troublesome affecting family and work life,treatment is needed along with emotional support and and encouragement for healthy lifestyle to manage her risk factors.